als core ecg rhythm by dr vijaykumar silvaraja
TRANSCRIPT
![Page 1: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/1.jpg)
ALS Core ECG Rhythm
![Page 2: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/2.jpg)
Sinus tachycardia
Defining Criteria
Rate >100 per minute
QRS Complex Normal and P for every QRS complex
Rhythm Sinus
P wave Present
![Page 3: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/3.jpg)
Atrial ectopic
Defining Criteria
Rate Sinus rate
QRS Complex Normal and narrow
Rhythm Regular sinus with atrial ectopic beat
P wave Normal P wave with presence of ectopic atrial beat
![Page 4: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/4.jpg)
Atrial fibrillation
Defining Criteria
Rate Wide range of ventricle response
QRS Complex Present
Rhythm Irregular
P wave Chaotic atrial fibrillatory waves
![Page 5: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/5.jpg)
Atrial flutter
Defining Criteria
Rate Atrial rate 100 to 350 per minute
QRS Complex Present
Rhythm RegularVentricular rhythm often regularSet ratio atrial rhythm eg. 2 to 1
P wave No true P wavesFlutter waves in “sawtooth” pattern
![Page 6: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/6.jpg)
Accessory-mediated supraventricular tachycardia
Defining Criteria
Rate Atrial rate 120 to 150 per minute
QRS Complex Normal and Narrow
Rhythm Regular
P wave Seldom seen due to rapid rate because p wave “hidden” in preceding T waves
![Page 7: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/7.jpg)
Sinus bradycardia
Defining Criteria
Rate <60 per minute
QRS Complex Normal
Rhythm Regular sinus
P wave Normal, every P wave followed by QRS complex
![Page 8: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/8.jpg)
First degree AV block
Defining Criteria
Rate Sinus rate
QRS Complex Normal and narrow
Rhythm Regular sinus
P wave Normal, every P wave followed by QRS complex
PR interval Prolonged > 0.20 sec and fixed
![Page 9: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/9.jpg)
Second degree AV block Morbitz type 1 (Wenkebach)
Defining Criteria
Rate Sinus rate
QRS Complex Normal and narrow
Rhythm Regular sinus
P wave P wave not followed by QRS complex
PR interval Progressive lengthening of PR interval occurs from cycle to cycle, then one P wave is not followed by QRS complex -“dropped beat”
![Page 10: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/10.jpg)
Second degree AV block Morbitz type 2
Defining Criteria
Rate Usually 60 to 100 per minute
QRS Complex Normal and Narrow(Wide QRS complex implies low block relative to AV node)
Rhythm Atrial regular, ventricular irregular
P wave Some P wave not followed by QRS complex
PR interval Constant and set, no progressive prolongation
![Page 11: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/11.jpg)
Third degree AV block
Defining Criteria
Rate Atrial rate 60 to 100 per min, dissociated from ventricle rateVentricle rate depend on rate of ventricle escape beats
QRS Complex Narrow implies high block relative to AV nodeWide implies low block relative to AV node
Rhythm Atrial and ventricular rate regular but independently “dissociated”
P wave Normal
PR interval Variable
![Page 12: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/12.jpg)
Ventricle ectopic
Defining Criteria
Rate Sinus rate with presence of ventricular ectopics
QRS Complex Normal QRS complexes with presence of single broad QRS complex
Rhythm Sinus rate with irregular ventricular rate
P wave Present before normal QRS complex
![Page 13: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/13.jpg)
Ventricular bigeminy
Defining Criteria
Rate Sinus rate with presence of ventricular ectopic
QRS Complex Normal QRS complexes with alternating broad QRS complexes
Rhythm Sinus rate with alternating ventricular rate
P wave Present before normal QRS complex
![Page 14: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/14.jpg)
Couplet
Defining Criteria
Rate Sinus rate
QRS Complex Normal QRS complexes with presence of broad QRS complexes in Couplet
Rhythm Sinus rate with irregular ventricular rate
P wave Present before normal QRS complex
![Page 15: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/15.jpg)
Monomorphic VT
Defining Criteria
Rate S>100 per minute, typically 120 to 250 per minute
QRS Complex Wide and bizarre, PVC like complexes >0.12sec
Rhythm Regular ventricular rate
P wave Seldom seen but present
Fusion beat Occasional chance capture of a conducted P waveResulting QRS “hybrid” complex, part normal and part ventricle
Nonsustained VT Last <30 seconds
![Page 16: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/16.jpg)
Polymorphic VT
Defining Criteria
Rate 150 to 250 per minute
QRS Complex Display classic spindle-node pattern
Rhythm Irregular ventricular rhythm
P wave Non-existent
![Page 17: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/17.jpg)
Torsade de pointes
Defining Criteria
Rate 150 to 250 per minute
QRS Complex QRS showed continually changing of axis (hence ‘turning of point’)
Rhythm Irregular ventricular rhythm
QT interval Prolonged
P wave Non-existent
![Page 18: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/18.jpg)
Ventricular fibrillation
Defining Criteria
Rate 150 to 300 per minute
QRS Complex Unable to determine; no recognizable P, QRS or T waves
Rhythm Indeterminate
Amplitude Can be described asfine (peak to trough 2 to < 5mm),or medium (5 to < 10 mm)or coarse (10 to <15 mm)or very coarse (> 15 mm)
![Page 19: Als core ecg rhythm by dr vijaykumar silvaraja](https://reader035.vdocuments.net/reader035/viewer/2022062420/55ce4a91bb61eb6b088b47d9/html5/thumbnails/19.jpg)
Asystole
Defining Criteria
Rate No ventricle activity
QRS Complex No deflection seen
Rhythm No ventricle activity